重症患者侵袭性真菌感染诊断和治疗指南.ppt
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参见附件(1076kb)。
内容提要
Pat at risk of developing IFD
The main players
? 1. SEC 1996-1998
Yeast fungi (candida): 91.4%
C albicans 40%
C tropicalis 60%
Mould fungi: 5.9%
? 2. PUMCH 1950-1990
Biopsy: Yeast fungi :15%
Mould fungi: 85%
Pathogenesis
invasive Candida infections
* Most systemic infections with Candida albicans are caused by endogenous organisms via translocation from the gastrointestinal tract or by sequential spread from other body sites
* Apparent outbreaks of infection have been reported, raising the possibility of horizontal transmission
* Average of 39% of surgical ICU staff were found to carry Candida species
* Infection control measures may be valuable
ICU患者念珠菌血症的高危因素
念珠菌感染的预后--高死亡率
Epidemiology of Invasive Aspergillosis Prospective Survey in France (1994-1999)
Invasive Aspergillosis in Critically Ill Pats without Malignancy
* 1,850 pats in a medical ICU
127例确诊/临床诊断曲霉菌病
Microbiological or histopathologic evidence of infection with Aspergillus: 6.9%
* Aspergillus fumigatus: 96%
* Aspergillus niger: 3 isolate
* Aspergillus flavus: 1 isolate
Crude Mortality for Invasive Aspergillosis
ICU患者侵袭性真菌感染的高危因素
内容提要
Defining invasive fungal disease
* 临床表现不典型，为基础疾病或药物治疗掩盖或混淆
* 合格标本获取不易，危重病人难承受侵入性检查
* 继发性感染常呈双重感染或复合菌感染，难以定主次
* 实验室检查手段有限，并有时效性？
* 结果的评判困难，难以确定病原性
* 危险因素+临床表现+影像学+实验室检查
重症患者IFI的诊治流程
内容提要
预防性抗真菌治疗
? 一般不主张预防性抗真菌治疗
? 预防性抗真菌治疗盲目性大、费用高，增加耐药性
? 但具有IFI危险因素的ICU重患可应考虑
- 具有高危因素的器官移植的危重患者
- 接受免疫抑制治疗的高危肿瘤患者
- 具有高危因素的粒细胞缺乏患者
- 高危的HIV患者
预防性抗真菌治疗
经验性治疗
Cordonnier C et al. Blood 2006; 108: abstr 2019
治疗小结
内容提要
Pat at risk of developing IFD
The main players
? 1. SEC 1996-1998
Yeast fungi (candida): 91.4%
C albicans 40%
C tropicalis 60%
Mould fungi: 5.9%
? 2. PUMCH 1950-1990
Biopsy: Yeast fungi :15%
Mould fungi: 85%
Pathogenesis
invasive Candida infections
* Most systemic infections with Candida albicans are caused by endogenous organisms via translocation from the gastrointestinal tract or by sequential spread from other body sites
* Apparent outbreaks of infection have been reported, raising the possibility of horizontal transmission
* Average of 39% of surgical ICU staff were found to carry Candida species
* Infection control measures may be valuable
ICU患者念珠菌血症的高危因素
念珠菌感染的预后--高死亡率
Epidemiology of Invasive Aspergillosis Prospective Survey in France (1994-1999)
Invasive Aspergillosis in Critically Ill Pats without Malignancy
* 1,850 pats in a medical ICU
127例确诊/临床诊断曲霉菌病
Microbiological or histopathologic evidence of infection with Aspergillus: 6.9%
* Aspergillus fumigatus: 96%
* Aspergillus niger: 3 isolate
* Aspergillus flavus: 1 isolate
Crude Mortality for Invasive Aspergillosis
ICU患者侵袭性真菌感染的高危因素
内容提要
Defining invasive fungal disease
* 临床表现不典型，为基础疾病或药物治疗掩盖或混淆
* 合格标本获取不易，危重病人难承受侵入性检查
* 继发性感染常呈双重感染或复合菌感染，难以定主次
* 实验室检查手段有限，并有时效性？
* 结果的评判困难，难以确定病原性
* 危险因素+临床表现+影像学+实验室检查
重症患者IFI的诊治流程
内容提要
预防性抗真菌治疗
? 一般不主张预防性抗真菌治疗
? 预防性抗真菌治疗盲目性大、费用高，增加耐药性
? 但具有IFI危险因素的ICU重患可应考虑
- 具有高危因素的器官移植的危重患者
- 接受免疫抑制治疗的高危肿瘤患者
- 具有高危因素的粒细胞缺乏患者
- 高危的HIV患者
预防性抗真菌治疗
经验性治疗
Cordonnier C et al. Blood 2006; 108: abstr 2019
治疗小结
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